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Malnutrition is an important concern in patients with acute stroke. It is a major factor contributing to poor outcome. There are several factors that are associated with malnutrition in acute stroke. Hypermetabolism, associated with acute illness, is one of the major factors. I have examined the metabolic changes after acute stroke and the methods of assessing malnutrition in the light of the literature. The pathophysiological background of how the metabolic changes in acute stroke contribute to altered indices of nutrition has also been examined. The tools available for marking malnutrition in acute stroke are appraised on the basis of the pathobiology.